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Medical Quality Control

Location:
Pompano Beach, Florida, 33060, United States
Posted:
May 27, 2010

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***** ******

*** ** *** ***

Pompano Beach, Florida 33060

Home (954) ***-**** or (754) ***-****

*********@***.***

Objective:

Seeking a challenging position that offers an opportunity for

personal and professional growth.

Work Experience:

7/08-Present

Promise Healthcare Inc-Revenue Analyst-

. Prepares weekly Medicare and Commercial cash projections for

all assigned facilities

. Audits and adjusts any discrepancies reported in cash projections

. Prepares weekly Case Management Reports for all assigned facilities

distributing to CEO, COO, Case Management, HIM and Admissions.

. Prepares weekly statistics on current month revenue.

. Maintains current working knowledge of governmental reimbursement

rules, regulations, and strategies to assist management at all levels

in all entities in dealing with governmental rules and regulations

. Conducts reviews and/or analysis of other financial data on an ad-hoc

basis. Compilation of the information could require extracting data

from several databases to enable complete and accurate information is

utilized. Analysis required will range from low to high level in

complexity.

. Communicates with the Director of Revenue Management to keep him/her

informed of day-to-day work activity as well as potential situations

that may arise

. Maintains a Working knowledge of all software, including, but

not limited to CPSI, Microsoft Word, Outlook, Microsoft,

Meditech, Medicare PC pricier, Internet Explorer, Ebos,

Direct Data Entry (DDE) and Code manger.

. Special Projects as assigned.

09/06-7/08

Promise Healthcare Inc-Billing Specialist-

. Work and update the Daily discharge log for account tracking.

. Responsible for billing and Collection of all Medicare and

Secondary commercial accounts as well as ensuring that the

claims are filed in a timely manner.

. Research denials, validity of questionable diagnosis codes,

procedure codes billable and inviolable revenue codes as well

as the above mentioned.

. Manage and work appeals, refunds and credit adjustments.

Assist with Bad debt reports.

. Maintains quality control of various reports to ensure proper

billing and collections of all accounts.

. Reviewed accounts and assigned those that require medical

records or further review.

. Assist in training of new hires on billing and system

policies and procedures.

. Maintains a Working knowledge of all software, including, but

not limited to CPSI, Microsoft Word, Outlook, Microsoft,

Meditech, Medicare PC pricier, Internet Explorer, Ebos,

Direct Data Entry (DDE) and Code manger.

01/05-8/06

Cymetrix (Out-source Vendor for Tenet Patient Financial Services)

Reimbursement & Adj Reconciler

. Handle work lists for 16 South Florida hospitals doing

Patient Transfer payments, Insurance transfer payments, and

high volume Payment research projects.

. Review patient accounts for duplicate or under-paid claims

and reconcile the patient accounts or process the payment to

the correct patient account.

. Request Patient Medical Records for unpaid claims and re-bill

to ensure payment unpaid claims.

. Audit accounts for coding and re-bill.

. Update or change invalid Payor codes to ensure proper

contract Reimbursement of claims.

. Liaison between out-source vendor and Tenet Regional Business

office for any data or claim/account corrections to resolve

patient accounts.

3/02-12/04

AHC Inc. Workers Comp/ Health Insurance CSR/ Collector Team

Leader/Senior Claims Rep

. Manage five or more collectors performing daily and monthly

review of accounts accuracy and job performance's.

. Maintained a work schedule of 100 or more accounts by

contacting insurance carrier, employer, and/or patients by

phone, mail or fax to ensure prompt resolution and payment of

medical bills or denied claims.

. Review UB 92, HCFA 1500, Medical Records, EOB, Contracts and

Itemized statements for accurate processing and filling of an

appeal to have a denial overturned.

. Request necessary information from AHC's client using forms

prepared in Microsoft Word of logs created in Microsoft

Excel.

. Maintains Working knowledge of all software, including, but

not limited to FACS, Microsoft Word, GroupWise, Microsoft

Internet Explorer and Code manger.

. Maintains a manageable work schedule through prioritization

of accounts and duties.

. Maintains confidentially of patient information at all times,

including but not limited to the medical records.

Education:

1998 graduate of Blanche Ely High School of Pompano Beach, Florida

Diploma 3.0 GPA

Reference upon

Request



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